Archive for the ‘Skin’ Category

It is not enough to know that the risks of treatment exist, but to understand why they exist, so that you know what precautions can be taken to reduce the risk of a complication.

How Safe are IPL and Cosmetic Laser Treatments?

Laser and Intense Pulsed Light (IPL) devices have been used in the medical community for over 25 years, and the amount of treatments performed has increased exponentially since then. According to the” American Society of Plastic Surgeons”, over a million Laser Hair removal treatments were performed in 2017 alone, which is up 48% from 2000. Laser Resurfacing (including fractional laser) is up 244% from 2000. According to a study published in the “Journal of Clinical and Aesthetics and Dermatology” the existing evidence base of over 25 years of use, to date has not raised any concerns over the long term safety. With millions of laser and IPL treatments successfully performed each year, these treatments are considered generally safe, however all of these treatments come with inherent risks.

The risks associated with laser and IPL treatments include lack of results, burns, blisters, infection, hyper-pigmentation, hypo-pigmentation and in severe cases scars. Prior to treatment patients sign an informed consent, not only consenting to treatment, but also that the understand and except the risks associated with treatment.

Why Do The Risks Exist

(This is about to get technical, but it is important)
Laser and IPL devices work on the principle of photothermolysis or selective absorption. There are a variety of wavelengths and each wavelength targets a specific chromophore, such as water, hemoglobin/blood or melanin. The laser used in treatment will depend on what your intended target is. For example, if you want hair removal or to address brown spots, a laser with a wavelength that is well absorbed by the melanin (color) is used. The goal is for the ratio of absorption in the intended target (in this case hair or a brown spot) to have greater value than the that of the surrounding skin. To put it more simply, we want the skin to be lighter than the hair or brown spot. The more contrast between the color of the brown spot or hair, compared to the color of surrounding skin, the more effective the treatment. It also makes the treatment safer, because the heat is confined to the targeted lesion, without damaging surrounding tissue. If someone is tan or has had unprotected sun exposure, the melanin levels in skin increase, so now instead of just the intended target absorbing the laser energy, the surrounding tissue will also absorb the energy. This is why tan skin is prone to a burn. The same concern applies to darker skin types. A majority of cases occur due to incorrect parameters being selected, based on patients skin color or ethnicity.

This explains in part, why there are more burn complications resulting from IPL and Laser Hair Removal treatments compared to laser resurfacing. There is also a misconception that these treatments are less aggressive and some how easier to perform. In fact, it could be argued that IPL is among the most technique dependent treatments. Part of what makes IPL devices so popular is it’s many applications. (I’m about to get technical again, only to demonstrate my point) IPL has such great versatility because, unlike lasers which only use a single wavelength, it uses a broad band of wavelengths. In each treatment, a provider must select an appropriate “cut-off” filter, based on which wavelengths you want to filter out. In addition to choosing the appropriate filter, the provider must select the energy used, pulse duration and with some of the more advanced devices the provider can select the number of pulses in each shot along with the delay time between these pulses. All of these parameters can allow an experience laser technician to provide a safer and more effective treatment, however there is also more chances for error.

Another risk factor that is rarely discussed, is the reliability of the equipment. As these aesthetic laser treatments have become more popular, so has the demand to produce them. It should not be assumed that just because a device is new, that it is better. Often, when a device or technology has been used with success, we will see other versions being produced by competitors, which may be cheeper, less effective and possibly less safe. Not all devices are created equal, I often use the comparison of a smart phone vs a flip phone. Both are phones, both can perform basic tasks such as texting or making a phone call, but we understand that a smart phone has many other uses and is technically superior.

Uncertified refurbished devises or devices that have been purchased second hand may have defects that cause serious complications. An even bigger concern is knock-off and counterfeit devices. In 2014 there was an article published in the journal “Laser in Surgery and Medicine” warning of counterfeit devices. They found that the problem was more prevalent than most physicians and consumers imagined. The article pointed to 29 knock-off versions of CoolSculpting and at least five counterfeit versions of Ultherapy. Many of these counterfeit devices are produced in China and South Korea, and look remarkably similar to the real thing. These counterfeit devices are unregulated and not approved by the FDA, they are also illegal to purchase, however they are purchased from distributers and online. These counterfeit devices do not have the safety mechanisms required, and have resulted in many reported cases of injury.

Reduce the Risk – Check List

Does the laser technician have the proper certification and training?
Regulations vary by state. As of August 2018, Arizona certifications will be renewed with the Arizona Department of Health Services (Bureau of Radiation Control). In Arizona a Certified Cosmetic Laser Technician must also be specifically certified for each laser application they provide. The approved applications are clearly listed on the certificate which must be posted. A certification only guarantees that the technician has met the minimal requirements to obtain a certification, so ask about their level of experience and any additional education they may have received. Good questions would include, how long have they been a laser tech, how long have they worked at that specific clinic, how long have they been providing the specific treatment your interested in.

Does the clinic have the proper license and certifications
The clinic must also be licensed and have all the laser devices registered with the appropriate regulating agencies. The certificates must be posted and it will include a list the devices that clinic has registered.

Who and Where is the Medical Director?
Alway ask who the Medical Director is, and if they are on site. Many med spas hire a medical director who is never or almost never on site. You want to know, that if you need medical attention or a prescription ( such as burn ointment),that they will be available. In my experience, there is more accountability when it is an actual medical practice with direct supervision from a doctor.

Is the device being used authentic used and reliable
The best way to determine if the device is authentic, is to go to the manufacture website and use the provider search. Most Laser manufactures will have a place on their website where you can enter a zip code and it will list approved providers in that area. You can also ask if they purchased it new, directly from manufacture and if they regularly service their device.

Red Flag Price
The most advanced lasers are obscenely expensive to purchase and maintain.Technicians that are highly qualified and experienced demand higher wages. All of the cost of providing the service is reflective in the price of treatment.

Disclose medical conditions, medications, supplements and topical products used.
Don’t just skip through your patient intake forms, those questions are there for a reason. Some medications and supplements increase photosensitivity and many medical conditions can inhibit healing. Always let your provider know if you are on accutane, antibiotics, pregnant or trying to become pregnant. Also inform your provider of topical products you use, such as retinoids, acne products and skin cancer treating drugs. Discuss any changes prior to each treatment.

Disclose sun exposure history
This is the big one! Your provider must know exactly how much sun exposure you have had, prior to EVERY treatment. Do not make any assumptions about, what counts. Everything counts! Tell them which sunscreen you use, and it’s even better if you bring it with you. Tell your provider your typical dosage, how much you apply to an area and how frequently. Also discus your ethnicity. Some people have lighter skin, but their ethnicity may make them more susceptible to a complication.

Discuss with your provider the potential risks
Be sure that you clearly understand the risks involved and how likely they are to occur. This is the time your provider should let you know what things you can do to reduce the potential of having a negative reaction. This may include, preconditioning skin prior to treatment, avoiding unprotected sun exposure, avoiding heat post treatment, waiting until you have finished a certain medication. Don’t underestimate the value of taking a comprehensive approach to address your concerns. The treatment you seek out, may not be the most appropriate treatment to start with.

Prior to treatment, ask your provider how they would address any complications
Do not wait and see if you will a problem to find out if your provider would be able to address it. Some side effects or complications, such as swelling and bruising will simply require time to resolve. There are things that can reduce the duration of a bruise or swelling, however it is not required. Other complications, like an infection, a burn or hyper pigmentation need to be addressed quickly. If a provider does not already have a plan for addressing a complication, it would be wise to get a second opinion before having a treatment.

It should also be noted that products, medications and additional treatment needed to treat a complication are not included with the cost of treatment and would be an additional cost to the patient. Do not assume you will get your money back if you are not satisfied or have a complication. You are paying for services rendered and you are consenting to the treatment knowing and excepting the risks involved.

Intraceuticals revolutionized the use of multi-weight Hyaluronics as both exceptional hydrator as well as an effective delivery system. The patented 3-step hyaluronic layering combines 3 specific combinations of hyaluronics, which work together to provide perfect hydrodynamics.

1) Low Molecular Weight Hyaluronic Acid – small, fast and easily absorbed to deeply hydrate skin.
2) High Molecular Weight Hyaluronic Acid – draws moisture from the air and binds moisture to skin.
3) Hyaluronic Polymer – a longer lasting form that works on the surface to seal in hydration and maintain infusion results

Oxygen Facials Options

There are a variety of Intraceuticals Oxygen Facial treatment that may be used to fit individual needs. Treatments may be “boosted” with collagen, vitamins and antioxidants or upgraded to include an Atoxelene targeted treatment for lines. In a clinical setting treatments are often customized by adding an enzyme treatment, mild peel, derma planing or microdermabrasion for exfoliation. Oxygen facial treatments are also excellent in conjunction with skin tightening treatments such as Forma or ReFirm .

Rejuvenate
Ultimate in hydration, the rejuvenate serum is formulated with hyaluronic acid, vitamins A, C, E and antioxidants to lift tone and hydrate skin. Appropriate for all skin types, and excellent as part of a skin recovery program after chemical peels, non-ablative laser resurfacing and IPL.

Antioxidant – Revitalize and balance dull and stressed skin with natural super fruits from Australian Rainforest.

Add A Mask!

Lip Mask
Super hydrators Hyaluronic Acid and brown algae provide a burst of hydration, to hydrate and soften the lips and skin surrounding mouth, defining the lip line. The Intraceuticals Lip masks may be added to an oxygen facial or purchased for at home use.

Eye Mask
Hydrolysed plant proteins helps to soothe and hydrate and tighten tired, puffy and overworked eyes.The Intraceuticals eye masks may be added to an oxygen facial or purchased for at home use.

Fractora is skin treatment, that delivers RF (RadioFrequency) energy to the dermal tissue of the skin through an array of tiny pins similar to micro needles. Fractora delivers improvements in the broadest range of symptoms of aging skin including sagging skin, improve definition, fine lines, deep lines, texture, even visible blood vessels in the face. It is also effective for addressing acne and reducing the appearance of acne scars.

How Does Fractora Work

Fractora uses tiny needle like pins to precisely deliver RF energy to various selectable depths in the skin. While laser resurfacing procedures work from the top down, Fractora works from the bottom up, allowing for safe treatment to deeper layers of the dermis. Similar to fractional laser treatment, fractora treats a “fraction” of the total surface area, so the untreated skin between the pins helps to promote faster healing of the treated tissue. As with all fractional treatments, more than one treatment is recommended. Typically 3 treatments are scheduled about 3-6 weeks apart.

Anti-Aging, Lines, Texture and Lax Skin

Acne and Acne Scars

Sometimes, a treatment that is originally designed to address one issue, can has the surprising benefit of addressing another. In this case Fractora, is effective at reducing acne lesions. Research suggests that this may be due to a temporary shrinking of the sebaceous (oil) gland. This is exciting news, because in the past we would want to have acne well-controlled before treating acne scars, and now there is potential to address both at the same time.

Broken Blood Vessels and Rosacea

Fractora has been shown to reduce visible vessels around the nose and on the face. Although, it has been shown to treat broken blood vessels I would not consider RF Needling as a rosacea specific treatment per se. However, Fractora is certainly an option to be considered for rosacea sufferes looking to also address acne that may be assosiated or signs of aging like fine lines.

Neck and Body

Fractora is commonly used on the face and neck, but body areas may be treated as well, including chest, arms, abdomen and thighs. It may be used to improve skin texture on non-facial skin or improve stretch marks or scars on the body.

Dermalinfusion goes beyond a typical facial, microdermabrasion or even a hydrafacial, it is a comprehensive and fully customizable treatment designed to address a wide variety of skin concerns.

Dermalinfusion uses medical grade diamond-tips with pneumatic pressure to gently lift and evenly exfoliate dry, dull layers of skin while simultaneously infusing condition specific serums directly into the epidermis to plump up fine lines and minimize pigmentation, while it is also extracting impurities to clarify pores. The serums are infused into the tissue using pneumatic pressure in a closed vacuum loop. The diamond tip is recessed in the hand-piece, and the vaccume pressure brings the skin up into the hand-pieces, where it is exfoliated, while simultaneously the pores are opened, so that the serums may be infused at the base of the pores and into the surrounding epidermal tissue. This deeply hydrating treatment volumizes the epidermis up to 70% and can also be performed over lips, around eyes and on non-facial skin.

Dermalinfusion Silk Peel treatments may be further enhanced by adding dermaplaning, enzyme or glycolic peel and treatment specific facial masks.

Click on image to enlarge

EXFOLIATION
A patented technology provides superior exfoliation with a wet-vacuum process that is more gentle than dry microdermabrasion. This controlled depth, technique is designed to give a uniform, even and precise exfoliation to smooth skin texture and brighten skin.

SERUM INFUSION
Specialized Pro-infusion serums are delivered deep into the skin and address specific skin conditions, such as acne, hyper pigmentation, sun damage and aging. This infusion also provides deep hydration and plumps skin by increasing epidermal volume for up to 72 hour.

Chlorophyll is a pigment found in green plants, which is vital for photosynthesis allowing plants to absorb energy from light. Chlorophyll, or more specifically the natural derivative, Sodium Copper Chlorophyllin offers many promising skin benefits.

Sodium Chlorophyllin Copper Complex can be found in topical enzymatic medications used for healing-debriding wounds. Chlorophyllin Copper Complex Sodium, expedites the healing of wounds by slowing the growth of certain bacteria on the skin, controls local inflammation and aids in the promotion of healthy granulations. It works to inhibit the inflammatory properties of protein degradation products in the wound, including the products of enzymatic digestion.

Hyaluronic acid is naturally occurring in the human body. It has the ability to bind to and hold about a thousand times it’s weight in water. In the dermal layers of the skin it provides moisture, plumpness, firmness and suppleness to the skin. With age, the production of hyaluronic acid in the skin declines progressively. Hyaluronic acid is degraded by the natural occuring enzyme, hyaluronidase. Sodium copper chlorophyllin has been shown to inhibit hyaluronidase and thus inhibit the breakdown of hyaluronic acid.

Phytochromatic MD® is a unique Sodium copper chlorophyllin in a liposomal complex, that has been shown to effectively penetrate skin. Skin care products containing Phytochromatic MD™ Complex have been shown to have anti-aging, antioxidant and anti-inflammatory properties, reduce redness, inhibit the breakdown of hyaluronic acid in the skin, and aid in improved wound healing. Phytochromatic MD® is currently found exclusively in MD Rejuvena skin care products.

The RS2 Facial is designed specifically for any dry skin with micro-circulation or vascular skin conditions, not just Rosacea. It is also ideal for anyone suffering from severe sensitivity, broken capillaries even hot flashes.

The RS2 Rosacea Facial features an alleviating Pevonia French Rose thermal clay mask, which provides soothing relief and visible results to dilated capillaries, congestion, blotchiness, and irritability. Comforting and healing ingredients such as: Rose, Green Tea, Chamomile and Liquorice, combine to properly decongest and calm your skin for an even, healthy appearance. These powerful natural ingredients known to help rosacea, Green Tea which is healing and anti-bacterial, Chamomile which has a calming and distressing effect on the skin and French Rose essential oil, which calms redness and reduces stress with its light, natural fragrance.

This treatment can be customized to include dermaplaning for gentle exfoliation, extractions and blue light therapy to kill bacteria for those who suffer with acne rosacea.

April has been designated as “Rosacea Awareness Month” by the National Rosacea Society (NRS). Rosacea is a progressive skin disorder commonly characterized by flushing and persistent redness on the central portion of the face and visible blood vessels. It has been estimated more than 16 million Americans are affected by Rosacea. The effects of Rosacea can go beyond this visible symptoms, often causing discomforts such as stinging and burning. For the majority of rosacea suffers it effects self esteem, going as far as to effect professional interactions.

What is Rosacea

Rosacea is a progressive skin disorder with symptoms including flushing, redness, visible blood vessels, burning, and stinging. Rosacea can also cause acne like symptoms, such as little bumps called papuals, often refereed to as Acne Rosacea. In more severe cases, there is a thickening of the skin and the nose can present as bulbous with irregular nodularities and enlargement, known as Rhinophyma. There is also a subtype of Roscacea, known as Ocular Rosacea, where eyes are red or bloodshot with burning and stinging. Rosacea is a progressive disorder and, left untreated, will worsen in severity with time. Those with Rosacea often experience flare-ups, which can last for months. Only a doctor can diagnose Rosacea. If you suspect you have Rosacea, see a dermatologist.

What causes Rosacea

The exact cause of Rosacea is not completely understood. Suggested possibilities include auto-immune disease or defects in the nervous system which effects blood vessels or Demodex mites. It may be something there is a genetic predisposition to. What we do know is that there is a strong vascular component to Rosacea. We also know that there are “triggers” such as heat or spicy foods that can trigger flare-ups.

Rosacea Treatment

It is important to understand that there is not a cure for Rosacea, but it is something that can be treated to reduce severity and symptoms. First, those with Rosacea should work to understand what their specific triggers are. Avoiding triggers can reduce the frequency and severity of flare-ups. Finding skin care products that do not aggravate rosacea can be tricky. Consult with a Dermatologist and Esthetician for skin care recommendations appropriate for Rosacea skin.

Intense Pulse Light (IPL) remains the most effective treatment for addressing the redness and visible dilated blood vessels seen with Rosacea. Vascular lasers, such as a KTP or Yag, can be used to treat facial veins that are well visible and can be traced. Typically, 3-6 treatments are needed, scheduled about 3 weeks apart. Because there is no cure for Rosacea, a series of treatments may need to be repeated annually, depending on severity.

Botox injections have been shown to be effective when injected superficially in very dilute concentration to reduce the redness and flushing of Rosacea. Redness may be reduced for 3-6 months after injections. This treatment is currently considered “off-label”.

Facials will not correct any vascular component of Rosacea, but the appropriate facial can calm and sooth skin. Consult with your Esthetician Facialist for recommendations.

There are countless skin care products available to treat skin discolorations known as “hyperpigmentation”, such as brown spots and melasma. There is also just as much confusion and misinformation, surrounding topical Hydroquinone and Non- Hydroquinone products. The fact is they are both necessary, as each have a place in correcting and maintaing pigment irregularities.

I am a proponent for Hydroquinone and for good reason, when used correctly it is arguably the most effective topical for treating hyperpigmentation. I am also a proponent for Non-Hydroquinone skin brighteners, because I do not support using Hydroquinone indefinitely without pulsing on and off.

About Hyperpigmentation

If you understand how hyper pigmentation occurs, you are better able to understand how to treat it. The process of producing pigment (melanogenesis) is complex, with many process, so I am giving the short version. When the skin has hyperpigmentation, it means that, there are melanocytes that are over producing melanin (pigment) AND that those pigment cells are not being evenly distributed to the skin cells called keratinocytes.

Something must first, trigger the increase of tyrosinase activity, this can be sun exposure, hormones or inflammation. Tyrosinase is an enzyme in the skin that controls the production of melanin. One of the main goals in treating hyperpigmentation is to inhibit the tyrosinase, so that it will not trigger the overproduction of melanin (pigment). Products that aim to do this use ingredients that we call “tyrosinase inhibitors”. Hydroquinone is a strong tyrosinase inhibitor, however there are also non-hydroqinone tyrosinase inhibitors that are effective.

Hydroquinone

Hydroquinone is a strong tyrosinase inhibitors and very effective at treating hyper pigmentation. There is concern, however that with extended use the skin may become resistant to the effects. This is why it is important to use hydroquinone under professional guidance. The general idea is to maximize correction, before you build resistance. Many dermatologists and skincare professionals are now recommending pulsing on and off hydroquinone. If you are using or plan on using hydroquionone products, I recommend you read “Hydroquinone: What you need to know, to maximize it’s benefits and prevent resistance”.

Non-Hydroquinone Brighteners

When you are pulsing off hydroquinone, you may want to use a non-hydroquinone skin brighter. Look for a brightener with tyrosinase inhibitors. Ideally, non-hydroquinone skin brighteners should be formulated with a combination of ingredients that will have an effect on the various stages of melanogensis (the formation of pigments). Antioxidants and exfoliants play a role in melanogensis and should be part of a skin care regimen, along with a tyrosinase inhibitor. I am including a short list of some commonly used ingredients in Non-hydroquinone brighteners.

Additional Tips

For best results begin by preparing your skin to best absorb the topical products you are using, this is done by properly cleansing and toning skin. Topical antioxidants and a broad spectrum SPF, are a MUST, because they help block the effects of “triggers”. We also recommend some type of chemical exfoliant, such as glycolic or lactic acid. These help by exfoliating melanin filled skin cells from the surface, which accumulate and cause pigment to be more dense, making it look darker. Retinoids such as tretinoin (Retina-A) work by inhibiting the transfer of pigment to skin cells, this blends pigment for even skin tone. Retinoids also work as a tyrosinase inhibitor. Finally, if you are not seeing the results you want with topical products alone, consult with a skin care provider to discuss which treatment options are best for you. Typically, we recommend chemical peels or PhotoFacials (IPL or BBL), depending on skin type and conditions being treated.

If you have not yet heard of Ultherapy it is a non-invasive procedure that is intended to lift and tighten the skin. It sounds almost to good to be true, right. So, the question is, does it really work?

The short answer is, yes it does work, but before you make any decisions, you need to know what kind of results can be expected. First, non-surgical treatments will always give a non-surgical result. If you are hoping for a cheeper alternative to a facelift, mini-facelift or even lifestyle lift, you will be disappointed with Ultherapy or ANY non-surgical treatment. During a traditional facelift the surgeon address lax facial muscle, fat and repositions the skin. Ultherapy is not a facelift and a facelift is not a skin treatment. One procedure does not replace the need for the other.

As we age collagen production progressively declines, which leads to wrinkles and thinning skin. Not to confuse facial volume (fat) loss, with skin (dermal/ epidermal) thinning, they are different concerns requiring different procedures. Like many of the treatments used in the world of medical aesthetic, Ultherapy is used to stimulate collagen. What makes Ulthera so unique is the way it stimulates collagen, where it stimulates collagen, the amount of increased collagen and the duration that collagen production is up regulated. Initially the targeted tissue will contract causing a tightening effect. As the renewal process continues collagen production is up regulated, improving skin density and giving a modest lift. The increased collagen is seen at multiple levels of the dermis, most prominent in the deeper dermal tissue. This up regulation of collagen continues, on average of a year.

An average of 69.5% improvement in dermal thickness is seen after Ultherapy

Although, Ultherapy is currently the only non-invasive treatment that can claim to lift skin, there are other treatments that can tighten the skin. Skin tightening is generally seen when aesthetic treatments target the dermal layer of the skin and stimulate collagen production. Ulthera works by targeting deep into the dermal tissue and also to the top of the facial muscle, leaving the surface intact. This is important because other non-surgical treatments, like RadioFrequency (RF) and laser do not treat at the same depth. Although, RF treatments can target fairly deep into the dermal area, the targeted area is only heated to a tempeture that will cause tissue contraction, this helps to tighten the skin. The difference is that RadioFrequency (RF) treatments do not heat the targeted area to the needed tempeture to achieve optimal collagen synthesis. Laser resurfacing and fractional resurfacing treatments, do heat the target area to optimal tempeture and will definitely generate significant collagen synthesis in the upper-mid dermis, which is ideal for treating lines, scars and skin texture. The difference is that we can not treat as deeply into the dermis with laser resurfacing as we do with Ultherapy. Most importantly, RadioFrequency (RF) and laser do not target the top of facial muscle, where Ultherapy does. Ultherapy does work, very well actually. Ultherapy is most appreciated when it is part of a comprehensive approach to anti-aging.

I can not tell you how many times I have been in the mall or a beauty store and heard a sales person give a shopper horrible advice on skin care. To the defense of the sales person, they probably are unaware they are giving poor advice, they are likely not trained skin professionals. Often the product they recommend cost just as much, if not more than the more effective cosmeceutical products used by skin professionals.

An in-depth consultation with an licensed Esthetician should be your first step to addressing aesthetic skin concerns such as aging. Even if you are just looking for professional advise on appropriate skin care to maintain your skin, a skin consultation is needed. Standing in the front office and talking to the office staff or even an Esthetician between appointments, does not cut it. Not everyone is qualified to give skin care advice, even the Esthetician can not give you the attention you need in 5 minutes. A full consultation is always the best way to go. We have put together a list of tips to help you get the most out of your skin consultation.

Select your Esthetician

An Esthetician is a skin care specialist, that has been educated and trained on skin health and beauty. They do not diagnose or treat medical skin conditions such as eczema, psoriasis, allergies or skin cancers. An Esthetician may work in a day spa, salon, med-spa or within a medical practice such as dermatology or plastic surgery. When selecting an Esthetician, be sure to ask about experience and training. Some Estheticians may have additional training or certifications to work in medical aesthetics. You should look for an Esthetician that fits your personal goals.

Be Prepared to Discuss Your Concerns

If you can help your Esthetician understand what you see, and what concerns you most, then they can better help you. We recommend you make a list of concerns and what you hope to improve. It may help to look in a mirror while creating your list. If you simply want to maintain your skin, we can help with that too. The more clear you are about your concerns, the more likely they will be addressed. You may have skin issues or signs of aging that do not bother you, your Esthetician does not want to offend you by suggesting that you improve something that you are content with. Estheticians understands that most people have a budget and we want to respect your money, so be sure to communicate the priority of your concerns.

What to consider:Pigmentation Concerns Is your skin color even or do you notice irregular pigmentation such as Melasma, dark patches, freckles, age-spots, sun spots or pigmented scars.

Acne / clogged pores Do you have any cysts, pimples, black heads, white heads or clogged pores. Do breakouts correlate with menstral cyle or hair removal. How often do you break out.

Texture Is your skin smooth and even or does it feel rough or flakey. Does your skin look creapy, have fine lines or scars that are raised or depressed.

Vascular Issues Do you have Rosacea, broken capillaries, diffused redness or red spots. Do you flush easily?

Aging concerns Do you have any lines, wrinkles, folds? Is your skin that lax or thinning. Is your facial volume plump and cohesive or do you see separation of the fat pads, hollowness of the face or under eyes, flat cheeks, or jowls? Do you have droopy or hooded brows?

Hair Even if you are only seeking skin treatments, let your Esthetician know if you experience unwanted hair, specifically facial hair and how you address it. Hair growth and hair removal methods may provide clues to skin issues. ( This applies to men and women) Some hair removal methods my be contraindicated to potential treatments or products. Estheticians specialize in hair removal methods, so they can provide you with or suggest the most appropriate hair removal methods.

Tell us what products you are using

Be prepared to talk to your Esthetician about the skin care products you have used in the past and are currently using. When filling out your consultation form, it is not enough to list a brand name or only including a couple products. We need a detailed list of the products you are using and it is even better if you bring the products in with you, so that we can read the ingredient list.

Not all skin care products or ingredients play well together, for example products with Benzoyl Peroxide can oxidize your topical antioxidants. Acne and anti-aging products usually active ingredients and if we mix too many, the skin may become very irritated. You may already be using something similar to what we would recommend and we do not want you to purchase something, if you already have it or something like it. Your Esthetician will try to work with your current products, when possible. Sometimes, however it may be necessary to start from scratch.

Tell us what you have done already

Think back to any cosmetic procedures or skin care treatments you may have had and make a list. Your Esthetician will need to know what procedures / treatments you have done. Some things should not be repeated too soon, while others my be contraindicated to each other. For example if you have had deep (full coverage) resurfacing procedures, your Esthetician will want to know because they can not be repeated too frequently. If you have recently had certain injectables, you may need to wait before having some procedures. If you have ever had any silicone injections or have you been on accutane, you need to alert your Esthetician.

Tell your Esthetician what you liked or did not like about the things that you have already done. If you had a good experience with something, that will provides a clue to how you respond to treatment. If you feel something did not work or you had a bad experience, we do not want to repeat that for you. Sometimes, your Esthetician may want to spend some time educating you on why you had that experience. Never assume anything is irrelevant.

Tell us a little more about you

Your Esthetician will want to know a little about your medical background and medications. Some medications may increase chance of bruising or cause photosensitivity. Do not forget to list any supplements or herbal treatments you may use. Remember to list any allergies, including food allergies, as some skin care products contain natural ingredients like pumpkin, papaya and pineapple. Medical conditions can effect how your bodies wound healing ability and how your skin responds to treatment. When listing medical conditions be sure to include any hormone therapy.

Your lifestyle and habits are important too. How do you exercise, are you on a restrictive diet, do you smoke, drink or use any other substance. We are not here to judge you, we need to take into consideration the variables that may influence how you will respond to treatment. If you have any special scheduling concerns, be sure to discuss them during your consultation.

Be clear on expectations

As you are discussing treatment options, be sure to clarify what you should expect. Often clients do not understand that they should expect some reaction with treatment or even some skin care products. Be sure you have an idea of what is normal and when you should be concerned. If you are having a treatment that involves any “down time”, your Esthetician will give you an idea of how long it will take to recover. Keep in mind, that this is just an estimated time frame. There are far too many variables that effect healing, it is impossible to predict exactly. It is also relative to what you consider to be “down time” and when it comes to your appearance being acceptable to return to work or social activities, everyone has different standards.

Before scheduling treatments, be sure you understand what typical results are. Often clients hear what they want to believe, expecting too much. Its tempting to hope that even if your Esthetician recommends a series of treatments, that you will be the exception. Sometimes we convince ourself that a non-surgical treatment will deliver a surgical result. We want to believe that one treatment can replace the need for others or that what we do at home isn’t that important. Try to keep your expectations realistic.

Consultation Fee

Be sure to find out about your consultation fee, often the consultation fee may be credited toward your first treatment. As a courtesy, many Estheticians offer a free consultation. This likely means they are not getting paid, so if you can not make your appointment, call to cancel or reschedule as soon as possible. A minimum of 48 hours prior to scheduled appointment is standard, this allows time to fill the space.